Tuberculosis
Tuberculosis in immigrants, HIV infection, and drug resistance have made tuberculosis more of a threat in the U.S. in recent years. Increases in the number of cases and outbreaks of this infectious disease have been a concern since the late 1990s. Tuberculosis is still relatively rare in the U.S. but a large health issue among at-risk groups.
Current guidelines call for targeted screening among groups at risk. Local health departments, health care providers, and certain employers promote screening based on local conditions and known risk factors.
Typically, if you have tuberculosis (TB), you do not feel ill or have symptoms. You have inhaled the germs from a contagious adult nearby, whose coughs or sneezes released the bacteria into the air. A reaction to a tuberculin skin test will reveal if you have been infected.
Although the Centers for Disease Control and Prevention discourages routine screening of low-risk populations, students and health care workers are often required to be tested before the first day of school or work.
Health care workers and others who risk exposure to the disease in their workplace or activities need to be screened periodically.
Persons who have had contact with an individual who has suspected or confirmed tuberculosis and persons with or at risk for HIV infection are the Centers for Disease Control and Prevention’s highest screening priority.
The American Academy of Family Physicians’ high-risk category includes the following groups:
Those with close contact to a person with known or suspected tuberculosis, health care workers, immigrants from countries with a high rate of this disease (generally, less industrialized, developing nations), people with HIV, alcoholics, users of injection drugs or other illicit substances, residents of long-term care facilities (such as nursing homes, mental health facilities, prisons, AIDS care facilities, and homeless shelters), and medically underserved, low-income people
Others vulnerable to infection:
The elderly and individuals whose immune systems are impaired, including persons whose medical conditions or therapies put them at greater risk
Persons who live in unclean or crowded places and those without healthy food
Infants, children, and adolescents: if they are exposed to high-risk adults, they should be tested
Links
A fact sheet on testing for tuberculosis is available from the Centers for Disease Control and Prevention at http://www.cdc.gov/nchstp/tb/pubs/tbfactsheets/250140.htm.
A good source of specific information on tuberculosis in children, adults, immigrants, and the elderly is the Virtual Hospital web site: http://www.vh.org/navigation/vh/topics/adult_patient_tuberculosis.html.
Sources
A brief history of tuberculosis treatment. New Jersey Medical School and National Tuberculosis Center, University of Medicine and Dentistry of New Jersey. 2001 Feb 26. Available on the Internet at http://www.umdnj.edu/ntbcweb/tb_frame.html. Accessed July 26, 2004.
American Academy of Pediatrics. Tuberculosis. Available on the Internet at http://www.medem.com/medlb/article_detaillb.cfm?article_ID=ZZZ1BN54FDC&sub_cat=573. Accessed July 26, 2004.
Centers for Disease Control and Prevention, Public Health Practice Office, United States Department of Health and Human Services. Targeted tuberculin testing and treatment of latent tuberculosis infection (American Thoracic Society/CDC statement). 2000 Jun 9. MMWR:49(RR06);1-54. Available on the Internet at http://www.phppo.cdc.gov/cdcRecommends. Accessed July 21, 2004.
D’Alessandro D and Huth L. Pediatrics common questions, quick answers: TB (tuberculosis). Children’s Virtual Hospital. Available on the Internet at http://www.vh.org/pediatric/patient/pediatrics/cqqa/tb.html. Accessed July 26, 2004.
Polgreen PM. Infectious disease (chapter 10). In: Tuberculosis, University of Iowa Family Practice Handbook (4th ed.). Available on the Internet from the Virtual Hospital at http://www.vh.org/adult/provider/familymedicine/FPHandbook/Chapter10/03-10.html. Accessed July 26, 2004.
Screening for tuberculosis and tuberculosis infection in high-risk populations: recommendations of the advisory council for the elimination of tuberculosis. 1995 Sep 8. MMWR:44(RR-11);18-34. Available on the Internet. Accessed July 21, 2004.
